Luca Ballarini and Michael Miaco
Luca Ballarini, (L), a crisis intervention clinician, and Michael Miaco, a nurse, work in the Psychiatric Emergency Services Unit at Toronto Western Hospital where they often help patients experiencing a mental health crisis. They say a conversation allowing the patient to articulate how they’re feeling can help bring stability. (Photos: UHN)

This is Bell Let's Talk Day, an annual opportunity to openly discuss mental health.

For Michael Miaco and Luca Ballarini, members of Toronto Western Hospital's (TW) Psychiatric Emergency Services Unit (PESU), which is often the first stop for those able to get to the hospital in a mental health crisis, a one-on-one conversation – on this day and every other – is a crucial tool to lessen a patient's fear and draw them out.

"Sometimes people come in thinking they want to kill themselves, and after an hour with one of us, they have a renewed hope," Luca, a crisis intervention clinician, says of the importance of talking.

"They feel better."

Luca says sometimes that's what it takes: an hour or more of just sitting and talking to a patient.

"I think we're always quite fundamental," he says of the unit's tight-knit team. "We help the Emergency Department (ED) because the Emergency physician cannot spend an hour with each patient, but we can."

Often being the first mental healthcare provider an ED patient will see, Michael, a nurse, says he knows the fears patients can have in seeking help for their mental illnesses.

There's a fear of stigma, of being a statistic, of being arrested, of hopelessness. There's also the fear of diagnosis, of being a mental health patient, of being judged by society, of facing the reality you denied for so long.

An opportunity to make people aware of services in the community

These are all things both men say they hear from patients.

Michael says a key part of his role is to understand and assess a patient through conversation with the patient, where they can communicate what they're feeling. He says it helps him to stabilize the person as soon as possible.

"Without creating this environment, it can often have the opposite effect and can actually increase fear and worsen a crisis," says Michael, adding that this open communication with a patient also allows for the opportunity to offer available services in the community that many otherwise wouldn't know existed.

"Patients are surprised when I mention 24/7 online mental health support," Michael says. "That in itself is help, and one of the reasons these conversations are crucial to have."

Given how deeply embedded communication is in what Michael and Luca do, it's not surprising the two believe the necessary safe space today's Bell Let's Talk Day provides for mental health conversations needs to span 365 days a year.

How do we get there? According to Michael and Luca, it's a combination of education, awareness, accessibility and funding.

"There's a fear that if we talk about mental illness and reflect on it, we might discover something we might not want to or something we've been in denial about or trying to ignore," Michael says. "And that's part of the stigma that coincides with society."

Luca says having those conversations helps address that fear, because they often invoke a chain reaction.

'It's all around us'

When he started telling colleagues about his personal experiences with mental illness in his family, he received a warm, open response from them: "my son was hospitalized too," "my mother is in the hospital for depression," "my brother hears voices," are all things he heard.

"These colleagues never told me about this until I told them first why I had to skip a few days of work," he says. "Suddenly, we have people admitting they have mental illness in the family, too.

"And, it's all around us."

To further address this fear, Luca says a mass education campaign on what mental illness is and isn't would help.

"For example, there are people who are bipolar who are doctors and lawyers," Luca says. "This is the reality."

People with mental illness are not much different from people with heart disease or cancer, Luca says. They're just going through something else.

"If your heart can get disease, why not your brain," he says.​

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